[Olive oil consumption and incidence of diabetes mellitus, in the Spanish sun cohort]. / Consumo de aceite de oliva e incidencia de diabetes mellitus en la cohorte española seguimiento Universidad de Navarra (SUN).

INTRODUCTION: The beneficial effects of the overall Mediterranean dietary pattern on cardiovascular risk factors and on carbohydrate metabolism are well known; however, it is unclear whether the consumption of olive oil in particular is able to reduce the incidence of type 2 diabetes. OBJECTIVE: To evaluate the specific effect of olive oil consumption on the risk of developing type 2 diabetes mellitus in a large Spanish cohort (the SUN Project). METHODS: We followed up 10,491 participants for a median of 5.7 years. Habitual diet was assessed at baseline with a semi-quantitative 136-item food-frequency questionnaire previously validated in Spain. The outcome of interest was incident type 2 diabetes diagnosed by a physician and confirmed by review of a medical report. The multivariate-adjusted odds ratios for incident type 2 diabetes for each of the 4 upper quintiles of olive oil consumption using the lowest quintile as the reference were assessed using logistic regression models. RESULTS: At baseline mean age was 38.9 + 11.38 year with a BMI of 23.8 + 3.41 kg/m². Forty two new cases of diabetes mellitus were diagnosed during follow-up. The adjusted odds ratio for the highest vs. the lowest quintile of consumption of olive oil was 1.11 (95% CI: 0.45-2.78; p for trend = 0.32). CONCLUSIONS: We found no association between olive oil consumption and the incidence of type 2 diabetes. The lack of association could be attributed to the small number of observed incident cases of diabetes. Further studies in Mediterranean countries with a longer follow-up and a higher baseline risk are needed to evaluate this association.

Consumo de aceite de oliva e incidencia de diabetes mellitus en la cohorte española seguimiento Universidad de Navarra (SUN) / Olive oil consumption and incidence of diabetes mellitus, in the spanish SUN cohort

Introducción: Se conoce el beneficio de la dieta mediterránea sobre los factores de riesgo cardiovascular y sobre el metabolismo hidrocarbonado. No está claro sin embargo, el papel particular del aceite de oliva sobre la incidencia de diabetes mellitus tipo 2. Objetivo: Evaluar el efecto específico del consumo de aceite de oliva sobre el riesgo de desarrollar diabetes mellitus tipo 2 en la cohorte española Seguimiento Universidad de Navarra. Métodos: Un total de 10.491 participantes seguidos durante una media de 5,7 años fueron incluidos en el análisis. La valoración dietética inicial se realizó mediante un cuestionario previamente validado y con un total de 136 ítems. El evento de interés fueron los nuevos casos de diabetes incidente diagnosticados a los participantes durante el seguimiento mediante evaluaciones repetidas cada dos años. Se estimaron los riesgos relativos (odds ratios) de diabetes asociados a cada nivel de consumo de aceite de oliva (quintiles) mediante modelos de regresión logística para ajustar por posibles factores de confusión.Resultados: La edad media fue de 38,9 + 11,4 años, con uníndice de masa corporal de 23,8 + 3,4 kg/m2. Se detectaron durante el seguimiento 42 nuevos casos de diabetes mellitustipo 2. No hubo relación estadísticamente significativa entre el consumo de aceite de oliva y el riesgo de diabetes. La odd sratio ajustada para el quintil superior (vs. el inferior) fue de1,11 (IC 95% 0,45-2,78) (p de tendencia = 0,32).Conclusiones: No hemos encontrado asociación entre el consumo de aceite de oliva y la incidencia de diabetes tipo 2 en esta cohorte. La ausencia de asociación encontrada se podría atribuir a los pocos casos incidentes en una población sana y con pocos factores de riesgo. Probablemente sea necesario un seguimiento más prolongado de una cohorte Mediterránea con mayor riesgo basal para poder evaluar esta asociación (AU)

Introduction: The beneficial effects of the overall Mediterranean dietary pattern on cardiovascular risk factors and on carbohydrate metabolism are well known;however, it is unclear whether the consumption of olive oil in particular is able to reduce the incidence of type 2 diabetes.O bjective: To evaluate the specific effect of olive oil consumption on the risk of developing type 2 diabetes mellitus in a large Spanish cohort (the SUN Project).Methods: We followed up 10,491 participants for amedian of 5,7 years. Habitual diet was assessed at baseline with a semi-quantitative 136-item food-frequency questionnaire previously validated in Spain. The outcome of interest was incident type 2 diabetes diagnosed by a physician and confirmed by review of a medical report.The multivariate-adjusted odds ratios for incident type 2 diabetes for each of the 4 upper quintiles of olive oil consumptionusing the lowest quintile as the reference were assessed using logistic regression models. Results: At baseline mean age was 38,9 + 11,38 yearwith a BMI of 23,8 + 3,41 kg/m2. Forty two new cases of diabetes mellitus were diagnosed during follow-up. The adjusted odds ratio for the highest vs. the lowest quintile of consumption of olive oil was 1.11 (95% CI: 0.45-2.78; pfor trend = 0.32).Conclusions: We found no association between olive oil consumption and the incidence of type 2 diabetes. The lack of association could be attributed to the small number of observed incident cases of diabetes. Further studies in Mediterranean countries with a longer follow-up and a higher baseline risk are needed to evaluate this association (AU)

Dietary fibre intake is inversely associated with carotid intima-media thickness: a cross-sectional assessment in the PREDIMED study.

OBJECTIVE: To assess the association between the intake of dietary fibre and carotid intima-media thickness (IMT) in a Mediterranean population at high cardiovascular risk. METHODS: Baseline cross-sectional assessment of 457 men and women (average age 67 years) from two different Spanish centres of the PREDIMED trial. A previously validated food frequency questionnaire (137 food items) was administered by trained dieticians in a face-to-face interview. Mean common carotid IMT was measured using B-mode ultrasound imaging of the right and left carotid arteries by four certified sonographers who used a common protocol. Anthropometric and blood pressure measurements were performed and samples of fasting blood were obtained. Participants were categorized into four groups (roughly quartiles: < or =21; >21 to < or =25; >25 to < or =31 and >31 g/day) of energy-adjusted intake of dietary fibre. Multiple linear regression models were used to adjust for age, sex, centre, smoking, body mass index, diabetes, blood pressure, lipid levels and statin use. RESULTS: In the crude analyses, energy-adjusted fibre intake showed a significant inverse correlation with IMT (r=-0.27, P<0.001). In multivariate analyses, a modest, though statistically significant (P=0.03) inverse association between energy-adjusted fibre intake and IMT was also found. The multivariate-adjusted difference in average IMT was -0.051 mm (95% confidence interval: -0.094 to-0.009, P=0.02) for participants whose intake was >35 g/day, (n=47) when compared with those whose intake was <25 g/day (n=224). CONCLUSIONS: Our results suggest that high fibre intake is inversely associated with carotid atherosclerosis.

La presión arterial domiciliaria se asocia con la hipertrofia concéntrica del ventrículo izquierdo / Home blood pressure is associated with concentric hypertrophy of the letf ventricle

Introducción. La hipertrofia del ventrículo se relaciona con el grado de hipertensión arterial e incrementa el riesgo de sufrir eventos cardiovasculares. Hay controversia acerca de la asociación entre las cifras de presión arterial medida por los distintos métodos clínicos y domiciliarios y la morfología ecográfica del ventrículo izquierdo. El objetivo ha sido investigar posibles asociaciones entre los parámetros ecocardiográficos de hipertrofia y las presiones clínicas y por automedida domiciliaria. Material y métodos. Se realizó determinación de presión arterial clínica y ambulatoria mediante automedida domiciliaria de presión arterial y ecocardiograma a 122 pacientes hipertensos (61,5% hombres). Se dividió a los pacientes según el patrón ecográfico del ventrículo izquierdo: normal, remodelado concéntrico, hipertrofia excéntrica y concéntrica. Resultados. Solamente 51 pacientes (41,8 %) mostraron un patrón ecográfico ventricular izquierdo normal. El 25,4 % tenía remodelado concéntrico y el 32,8 % hipertrofia ventricular izquierda. Existió asociación estadísticamente significativa entre la presión arterial sistólica clínica y el índice de masa de ventrículo izquierdo ajustando por edad, sexo e índice de masa corporal (ß = 0,004; intervalo de confianza del 95% [IC 95 %]: 0,001 a 0,007 [p = 0,022]), y entre la presión de pulso de automedida y el grosor relativo de pared (ß = 0,006; IC 95 %: 0,001 a 0,010 [p = 0,013]). La presión de pulso domiciliaria fue estadísticamente superior en los pacientes con grosor relativo de la pared mayor de 0,44. Discusión. Se han encontrado evidencias que sugieren la asociación de las mediciones de presión arterial de automedida con los patrones de remodelado e hipertrofia concéntrica que predicen mayor riesgo cardiovascular, las cuales no se relacionan con las mediciones clínicas. Estos resultados apoyan la utilización de automedida domiciliaria en la evaluación de los pacientes hipertensos

Introduction. Ventricle hypertrophy is related with the degree of arterial hypertension and increases risk of suffering cardiovascular events. There is a debate on the association between the blood pressure values measured by different clinical and home methods and ultrasonographic morphology of the left ventricle. The objective has been to investigate possible associations between echocardiographic parameters of hypertrophy and clinical pressures and by home self-measurement. Material and methods. Clinical and out-patient blood pressure was measured by home blood pressure monitoring and echocardiogram in 122 hypertensive patients (61.5 % men). Patients were divided according to the ultrasonographic pattern of the left ventricle: normal, concentric remodeling, eccentric and concentric hypertrophy. Results. Only 51 patients (41.8 %) had a normal left ventricular ultrasonographic pattern. A total of 25.4 % had concentric remodeling and 32.8 % left ventricular hypertrophy. There was a statistically significant association between the clinical systolic blood pressure and the left ventricle mass index, adjusting by age, gender and body mass index [ß = 0.004; 95 % confidence interval (95 % CI): 0.001 to 0.007 (p = 0.022)], and between self-measured pulse pressure and relative wall thickness [ß = 0.006; 95 % CI: 0.001 to 0.010; (p = 0.013)]. Home pulse pressure was statistically greater in patients with relative wall thickness greater than 0.44. Discussion. Evidence has been found that suggests the association of the self-measurement blood pressure measurement with remodeling patterns and concentric hypertrophy, that predict greater cardiovascular risk, these not being related with clinical measurements. These results support the use of home self-measurement in the evaluation of hypertensive patients

[Impact of common reasons for consultation on the feeling of vitality and the physical performance of the over-65s]. / Impacto de los motivos comunes de consulta en el sentimiento de vitalidad y en el rendimiento físico de personas mayores de 65 años.

OBJECTIVES: To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care. PARTICIPANTS: Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. METHODS: SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. RESULTS: The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of -11.2 points (95% CI, -18.6 to -3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of -7.7 points (95% CI, -13.9 to -1.5) and -10.3 points (95% CI, -19.1 to -1.6), respectively. Arthrosis symptoms behaved in a similar way. CONCLUSIONS: The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life.

Impacto de los motivos comunes de consulta en el sentimiento de vitalidad y en el rendimiento físico de personas mayores de 65 años / Impact of common reason for consultation on the feeling of vitality and the physical performance of the over-65s

Objetivo. Medir 2 dimensiones funcionales (vitalidad y rol físico) implicadas en la calidad de vida de las personas > 65 años y conocer qué relación mantienen con los motivos de consulta más habituales. Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria. Participantes. Muestra aleatoria de 179 pacientes > 65 años procedentes de 14 consultas de atención primaria de Navarra. Métodos. Cuestionario de calidad de vida SF-36 y motivos de consulta más frecuentes. Se recogieron también datos demográficos, familiares y de prescripción continuada de fármacos. Resultados. Los motivos de consulta más frecuentes fueron: insomnio (31,8%), artrosis (48%) y síntomas miccionales (16,2%). Las mayores diferencias en las escalas del SF-36 se produjeron en los pacientes con insomnio. Se observaron asociaciones inversas de cada uno de los motivos de consulta indicados con las dimensiones vitalidad y rol físico en los modelos de regresión múltiple. La vitalidad se asoció con presencia de síntomas miccionales, con un coeficiente β ajustado de –11,2 puntos (intervalo de confianza [IC] del 95%, –18,6 a –3,7). El insomnio se asoció con descensos significativos de la vitalidad y el rol físico, con β de –7,7 puntos (IC del 95%, –13,9 a –1,5) y –10,3 puntos (IC del 95%, –19,1 a –1,6), respectivamente. Un comportamiento similar se obtuvo para los síntomas artrósicos. Conclusiones. Las enfermedades o los síntomas más frecuentes que motivan consultas de atención primaria en > 65 años afectan significativamente a las dimensiones de la calidad de vida relacionadas con el desarrollo de una actividad diaria normal

Objectives. To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. Design. Cross-sectional, descriptive study. Setting. Primary care. Participants. Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. Methods. SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. Results. The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of –11.2 points (95% CI, –18.6 to –3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of –7.7 points (95% CI, –13.9 to –1.5) and –10.3 points (95% CI, –19.1 to –1.6), respectively. Arthrosis symptoms behaved in a similar way. Conclusions. The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life

Primary care nursing of coronary patients and reduction of re-infarction risk: a nested case-control study.

OBJECTIVES: To estimate the risk reduction for re-infarction achieved in primary health care centres. STUDY DESIGN: This was a case-control study nested in a cohort of coronary patients. POPULATION: Nine hundred and eighty-five coronary patients, aged less than 76 years who had survived for more than 6 months after their first acute myocardial infarction (AMI), were recruited from two public hospitals in Navarre, Spain. Cases (repeated myocardial infarction, n = 137) and controls (patients with one AMI who had not had a second infarction, [n = 137) who had not been treated with invasive procedures were extracted from this cohort and matched by gender, age, hospital and the secondary prevention time frame. OUTCOMES MEASURED: Re-infarction. RESULTS: In total, 31.4% of cases and 51.8% of controls attended the primary care nurse clinic regularly. This difference accounted for a significant reduction of the risk of re-infarction, even after adjustment for regular visits to the family physician, life styles (smoking, walking habit and dietary changes) and drug treatments (odds ratio: 0.48; 95% confidence interval: 0.26-0.89). A regular schedule of visits to the family physician showed no association with further coronary risk reduction. CONCLUSIONS: Regular attendance of coronary patients at a primary care nurse clinic is associated with a lower risk for re-infarction. Psychological rehabilitation could be the main reason for this benefit, since protection persists after adjustments for other known risk factors.

Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet.

Our objective was to develop a short questionnaire that can be easily used to estimate quantitatively the level of adherence to cardioprotective Mediterranean diets. The short questionnaire assessed the consumption of cardioprotective elements included in the Mediterranean diet (olive oil, wine, fruits, vegetables, fish, legumes and whole-grain intake). A low consumption of meat or meat-products was also included in the composite score. The relative risk of myocardial infarction for each category of the composite score obtained (range 0-9) was computed using data from a case-control study that included 171 cases of first myocardial infarction and 171 matched controls. We found an adjusted odds ratio=0.18 (95% confidence interval (CI): 0.03-0.97; P=0.04) for those scoring 7-9 points when comparing them with those scoring 1-2 points. An increment of one point in the score was associated with an 18% reduction in the relative risk of myocardial infarction (P=0.05).

To what extent are the effects of diet on coronary heart disease lipid-mediated?

BACKGROUND: Cohort and case-control studies support the effect of diet on coronary heart disease. The objective of this study was to analyze the strength of the influence of dietary fat subtypes and other nutrients on serum lipids levels in patients with a first acute myocardial infarction. METHODS: We studied 139 patients with a first myocardial infarction and no previous history of vascular disease. Serum lipids were determined, and nutrient intake was analyzed using a validated 118-food item questionnaire. RESULTS: Multiple regression models found weak but significant associations between the intake of different fatty acids and total to HDL cholesterol ratio (atherogenic index) when we adjusted for age, gender and body mass index (BMI). Positive associations with serum HDL cholesterol concentration were observed for energy-adjusted intake of red wine, alcohol intake, and omega-3 fatty acids intake. However, these nutrients explained less than 12% of the variability in the atherogenic index, and less than 17% in the variability of HDL. CONCLUSIONS: Our results suggest only a modest contribution of the investigated nutrients on serum lipids (atherogenic index and HDL cholesterol) in coronary patients. Alternative mechanisms of dietary factors not directly related with serum lipids or, more likely, a global effect of diet on inflammatory and antioxidant parameters should be studied in order to better understand the nature of dietary habits' influence on cardiovascular disease.

Oral lesions in recessive dystrophic epidermolysis bullosa.

OBJECTIVE: To study the prevalence of oral lesions in 35 patients diagnosed with generalized recessive dystrophic epidermolysis bullosa (RDEBg), with a quantification of their microstomia in comparison with a control group. MATERIAL AND METHODS: The presence of oral mucosal lesions and interincisal maximum oral aperture (MOA) was determined, classifying microstomia according to the method of Naylor, Douglass and Mix (1984). RESULTS: Blister lesions were identified in 92% of the patients at the time of exploration--the tongue being the most affected location. Microstomia and palatal atrophy were the most prevalent sequelae (100%), while ankyloglossia, vestibular obliteration and lingual depapillation were recorded in over 90%. In 80% of the patients interincisal MOA was <30 mm (severe microstomia), while in the remaining cases maximum aperture was in the range of 31-40 mm (moderate microstomia). CONCLUSIONS: Blister lesions were found throughout the oral mucosa in our series of patients with RDEBg, the most frequently affected location being the tongue. These lesions in turn led to invalidating sequelae such as microstomia and ankyloglossia.

Type of alcoholic beverage and first acute myocardial infarction: a case-control study in a Mediterranean country.

BACKGROUND: Although international comparisons have consistently found an inverse association between wine and coronary heart disease, few epidemiologic studies are available in Southern Europe. We assessed the association of wine, red wine, and the pattern of drinking wine during meals with the risk of myocardial infarction. HYPOTHESIS: We specifically evaluated three hypotheses: (1) Is the protection against incidence of nonfatal myocardial infarction stronger for wine than for other alcoholic beverages? (2) Does the wine consumed during meals represent a more beneficial pattern of alcohol consumption? (3) Is red wine more advantageous than other types of wine? METHODS: A case-control study (171 cases, 171 matched controls) was conducted in Spain. Multiple dietary and nondietary potential confounders were assessed. RESULTS: Exposure to wine, red wine, and wine during meals was associated with risk reductions similar to those of other alcoholic beverages (point estimates of the odds ratio for low and high intake were 0.48 and 0.38 for wine; 0.42 and 0.55 for other beverages). However, after controlling for total alcohol intake, wine consumption (g/day) improved the prediction of a myocardial infarction. CONCLUSIONS: Our data showed that red wine or drinking wine during meals was similar to alcohol from other sources for reducing coronary risk. However, an additional benefit of wine, keeping constant overall alcohol intake, deserves further research.

Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain.

OBJECTIVE: To assess the association between a first acute myocardial infarction and the consumption of fibre and fruit. DESIGN: Hospital-based case-control study with incident cases. A validated semi-quantitative food frequency questionnaire (136 items) was used to assess food intake. SETTING: Three third-level university hospitals in Pamplona (Spain). SUBJECTS: Cases were subjects aged under 80, newly diagnosed with acute myocardial infarction. Each case patient (n=171) was matched to a control subject of the same gender and age (5 y bands) admitted to the same hospital. RESULTS: An inverse association was apparent for the three upper quintiles of fibre intake. After adjustment for non-dietary and dietary confounders, an inverse linear trend was clearly significant, showing the highest relative reduction of risk (86%) for the fifth quintile (OR=0.14, 95% confidence interval: 0.03-0.67). An inverse association was also apparent for fruit intake, but not for vegetables or legumes. CONCLUSIONS: Our data suggest that a substantial part of the postulated benefits of the Mediterranean diet on coronary risk might be attributed to a high intake of fibre and fruit.

Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case-control study in Spain.

BACKGROUND: Olive oil is the main source of dietary lipids in most Mediterranean countries where mortality and incidence rates for coronary heart disease (CHD) are the lowest in Europe. Although international comparisons and mechanistic reasons support the hypothesis that a high olive oil intake may prevent CHD, limited data from studies of individuals are available. METHODS: A hospital-based case-control study was conducted in Pamplona (Spain) recruiting 171 patients (81% males, age <80 years) who suffered their first acute myocardial infarction and 171 age-, gender- and hospital-matched controls (admitted to minor surgery, trauma or urology wards). A validated semi-quantitative food frequency questionnaire (136 items) was used to appraise previous long-term dietary exposures. The same physician conducted the face-to-face interview for each case patient and his/her matched control. Conditional logistic regression modelling was used to take into account potential dietary and non-dietary confounders. RESULTS: The exposure to the upper quintile of energy-adjusted olive oil (median intake: 54 g/day) was associated with a statistically significant 82% relative reduction in the risk of a first myocardial infarction (OR = 0.18; 95% CI : 0.06-0.63) after adjustment for dietary and non-dietary confounders. CONCLUSIONS: Our data suggest that olive oil may reduce the risk of coronary disease. These findings require confirmation in further observational studies and trials.

[Differences between young and elderly patients in a protocol for the diagnosis and follow-up of arterial hypertension] . / Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial.

OBJECTIVE: To determine possible differences between the control of hypertension in elderly patients and in young patients. DESIGN: Retrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic check-ups, vascular disease and risk factors. SETTING: The urban Azpilagaña Health District in Pamplona. PATIENTS: 389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60. MAIN RESULTS: More older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (< 140/90) was achieved more often among young people (39.9% vs 26.5%, p = 0.005). In the older patients group initial higher diastolic pressure was related to final pressure control. More older patients had periodic check-ups at the health centre (73.3% vs 63.7%, p < 0.001), but this practice only improved relative control (< or = 140/90) in young people (p = 0.001). Older patients used more diuretics (p < 0.001) and less beta-blockers (p < 0.001), with no differences for other hypertension drugs. CONCLUSIONS: There are differences based on age in treatment and control of hypertension patients. Older patients with diastolic hypertension are controlled more easily. Altogether and in both groups analysed, the percentage of people with normal pressure after treatment was higher than in other studies.

Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial / Differences between young and elderly patients in a protocol for diagnosis and follow-up of hypertension

Objetivo. Determinar la posible existencia de diferencias en el control de la hipertensión en sujetos ancianos en comparación con hipertensos jóvenes. Diseño. Estudio observacional retrospectivo de las diferencias entre las tensiones arteriales sistólica (TAS) y diastólica (TAD) iniciales y finales, y su relación con la inclusión en tratamiento farmacológico, así como el control obtenido según tipo y cambios de tratamiento, asociación farmacológica, revisiones periódicas, enfermedad vascular o factores de riesgo. Emplazamiento. Zona Básica de Salud de Azpilagaña en Pamplona, con características urbanas. Pacientes. Se estudiaron retrospectivamente 389 hipertensos: 196 de 70 o más años y 193 de 45-60 años. Resultados principales. Más pacientes mayores fueron tratados con fármacos (91,8 frente a 84,5 por ciento, p = 0,024) y recibían tratamiento combinado con 2 fármacos (30,1 frente a 19,7 por ciento, p < 0,001), aunque son los jóvenes los que con mayor frecuencia reciben más de 2 antihipertensivos (11,4 frente a 2,5 por ciento, p < 0,001). El control final (< 140/90) se consiguió con más frecuencia entre los jóvenes (39,9 frente a 26,5 por ciento, p = 0,005). En el grupo de pacientes mayores la mayor tensión diastólica inicial se relacionó con el control tensional final. Más pacientes mayores siguieron las revisiones periódicas en el centro de salud (73,3 frente a 63,7 por ciento, p < 0,001), pero esta práctica sólo mejoró el control relativo (ó 140/90) en los jóvenes (p = 0,001). En pacientes mayores se emplearon más diuréticos (p < 0,001) y menos bloqueadores beta (p < 0,001), sin diferencias en otros antihipertensivos. Conclusiones. Hay diferencias en el tratamiento y control de los pacientes hipertensos en relación a su edad. Los pacientes mayores con hipertensión diastólica se controlan más fácilmente. En conjunto, y en ambos grupos analizados, el porcentaje de sujetos normotensos tras tratamiento es superior al reseñado en otros estudios (AU)